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� PA pepartment of Revenue Counly Code Year Fils Number
'� Bureau of IndNWual Taxes �NHERITANCE TAX RETURN
PO 8pX 280801 1
Narr�a, pn t7t2s-fleo� RESIDENT DECEDENT �i �� �
E R DECEDENT tNFtfftNfAT16N BELOW
& ai Security Number Date of Death MMDbYYVY Date of Birth MMODm�v
02082012 0322 3 9 53
p��° ni's lasi Name SufPa DecedenCS First Name MI
d� a mb a c h J u d y B
{M �PWicabk)Enter SurvFvinp 8pouse's IMormatlon Belaw
S�use's last Name Suttix Spouse's First Name MI
Spd�use's Socia€Seeurfty Number
THIS RETURN MUST BE FILED IN bURLICATE WITH THE
REGlS7ER QF WfLLS
Fl (tN APPROPRIATE OVALS 8EL8W
Q� t.Qriginal Ratum � 2.Supplementaf F2etum � 3.Remainder R�um(Uata of Death
Pdorto 12-13-82)
� A.lkrdted Estate � 4a.Futuro IMere�Gort�ramise(6ate of Q 5.Federal Eatate Ta�c Retum Requirad
death atter t2•12-82t .
[� 6.Dr,itadent Dkd Tostate ❑ 7.Decedent Maihtained a LWing Trust ..,_ 8.Total Number of Safe DeposR Bpxes
(Attach Copy pf Wfiq (Attach Copy of Trust.)
Q 9.i.NigaNnn Procaeds Received Q 10.Spousal Poverty CresiR{Date af Death � 1 t.Ekction to T�u�r Sec.9113{A}
Between 12•91-97 attd t-f-85) (Attach SChedaie 6}
CO RESPpNDENT�7WIS SECTqN MUBT BE CONIPLETED.ALL CORRESPONDENCE AND CONFIpENTUL TA%INFORMATION BHWLD 8E DIRECTEO T0:
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R a b e r t G . T e s t e r 7 1 7 3 ��__-4 2� 9 5
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� . BpSTER Ofi�l}LLS Y1SE LY
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First Line of Address �� "�� � � �
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Glet t ysbur g PA 17325
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StO 6f P � �SPQNSIBIE FQR FN.�RETURN pp'(E
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A S
42 irc wa Chambersbu PA 17242
SiG RE AR Oq!lR�PRESEH7ATIVE E
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R SS
108 . Middie Street Ge sbur PA 17325
PLEASE USE BRKiINAt FORM ONIY
' 51de 1
� 15p561014Q 1505610140 �
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Under penalties of perjury, I declaze that I have examined the attached
ennsylvania lnheritance Tax Return, including accompanying schedules and
tatements, and to the best of my lcnawledge and belief, it is true, correct, and
omplete.
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�ate �� ? , 2013
I Denise M. Lucas
I 1431 Moosic Drive
I� Chambersburg, PA 17202
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� 1505610240
.,,. REV�500 EX�F�) � ' Decederrt's Social Security Number
!i o��r,N,�: Judv B. Dambach
R CAPITULATION �
1 Real Estate(Schedule A) . . . . . . . . . .. . .. ... . . . .. . .. . . . . .. . ... . . . .. . .. 1. •
2 Stocksand Bonds(Schedule B) . . . . . . . . .. ... . . . .. . .. . .. . ... . . .. . . ... . 2. •
3 Closely Held�Corparetion,Partnership or Sole-Proprietorship(Schedule C) .. . .. 3. •
� 4 Mortgages and Notes Receivable(Schedule D) . . . .. . .. . .. . . .. . .. . . . . ... . 4. � •
5. Cash,Bank Deposits and Miscellaneous Pereonal Property(Schedule E). .. . . . . 5. •
6. Jointty Owned Property(Schedule F) ❑ Separate Billing Requested . . . .. . . 6. 4' 9 9 , 5 �
7. Inter-Vivos Transters&Miscellaneous -Probate Property
(Schedule G) � Separate Billing Requested . . . . ... 7. ,
8. Tohl Gross Asseffi(total Lines 1 through 7) . . .. . . .. . .. . .. . .. . . . . . .. . . . 8. 4 9 9 , 5 0
9. Funeral Expenses and Administrative Costs(Schedule H) . .. . . .. . .. . . . . ... . 9� 5 � 7 • 0 0
10 Debts of�Decedent,Mortgage Liabilkies,and Liens(Schedule I) . .. . . . . ... . .. 10. •
>>. 7om�oeduceons(rota�unes s and �0) .. ... . . ... . .. . .. . ... .... . . . . . . . ��. 5 1 7 . 0 0
12. Net Value of Eatate(Line 8 minus Line 11) . .... . ... ... ... . .. . . . .... . .. 12. - � 7 . 5 0
13. Chariteble and Governmental Bequests/Sec 9713 Trusts for which
an elec[ion to tax has not been made(Schedule J) . . ... .. ... .... . . . . . .. . 13: .
14. Net Value Subject to Tax(Line 12 minus Line 13) ... . .. .. . ... . . .. ... ... 14. - � 7 . 5 �
TA CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxabie
at the spousal tax rate,or
transfers under Sec.9116
(a)(12)XA _ � � . � 0 15. � � . � �
16. Amount of Line 74 taxable
at lineal wte X.0_ � . 0 � �g, � . � 0
77. Amount of Line 14 taxable
at sibling rete X.12 � . � 0 77. � . � �
18. Amount of Line t4 taxable
al wliateral rate X.15 0 . Q � 18, � . � 0
19. TAX DUE . . .. . . . . .. . . . . . .. . . . . . . .. .. . . . . . . . . .. . . . . . . . . . . .. . . . .. 19. O . O O
20. FILL IN THE OVA�IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
1505610240 1505610240 �
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REV-1500 EX(FI) Page 3 File Number
Decedenit's Complete Address: o 0
DECEDENT'S AME
Jud B. D mbach
STREETADD ESS
11 Dewber Court
CIN STATE ZIP
Mechanics urg PA 17055
Tax Payrt�ents and Credits:
�. Tax Due(page 2,Line 19) (1) 0.00
2. Credits/Pa,ymenis
A.Prior P2yments
B.Discouqt �
, Total Credits(A*8) (2) 0.00
3. Interest '
(3)
4. If Line 2 is greater than Line 1+Line 3,enter the diHerence.This is ihe OVERPAYMENT.
Fill in ova�on Page 2,Line 20 to requeat a refund. (4) 0.00
5. If Line 1 +�.ine 3 is g2ater than Line 2,enter the diflerence.This is lhe TAX DUE. (5) 0.00
Make check payable to REGISTER OF WILLS, AGENT
J� ; ? Y.. � .��� ,.� � . .� �,.�"�. ' �, >�. ,°�a, aA�MH�.�,,,� � G,r..i's,�, � . � ' . ��. .��� u �,k ��.G;��w r±." 'i'
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
', 1. Did decedent make a trans(er and: Yes No
a. retain the use or income of the propeAy iransferred ...................................................................... ❑ 0
b. retain Me nghl to designate who shall use the propedy transferted a its income ............................... ❑ �
, c. retam a reversionary interest ..................................................................................................... ❑ �
' d. receive the promise for IKe of either paymenis�benefds or rare? ....................................................... ❑ �
2. If death occurred aRer December 12,1982,did decedent transfer properry within one year of death
' without receiving adequate consideraGon7 ......................:................................................................ ❑ Q
' 3. Did decedent own an'in trust for'w payaW�.wpon�eath bank axount or securiry at his or her death7 ......... ❑ ❑x
', 4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a ben�ciary designalionl.................................................................................................. ❑ ❑X
IF THE ANSY+VER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FIIE IT AS PART OF THE RETURN.
� ; 'G. � h � ..I"� , nJi'!{ '-:eii r '� r n ¢; . � �"�' F ` " . ' ^ S -0I As.eRSF'�Vf �s� n�..enx-0#1"�+0�' "ui'i z
Fw dates of d N on oi aker July 1, 1994,and before Jan. 1, 1995,ihe tax rate imposed on the net value of hansfers to or for the use of the surviving spouse
is 3 percent(T P.S.§9116(a)(1 1)(i)].
For dates of de�ih on or after Jan. 1, 1995,fhe tax rate imposed on the net value of Vansfers to or for the use of the surviving spouse is 0 percent
p2 P.S.§9116I(a)(1.1)(ii)j.The statute dces not exempt a transfer to a surviving spouse from tax,and tt�e statutory requirements for disclosure of assets and
filing a tax retu�n are sGll applicable even if the surviving spouse is the only benefipary.
For dates of de U�on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased chlld 21 years of age or younger at death to or for ihe use of a nalural parent,an
adopdve p nt or a stepparent of fhe child is 0 percent[72 P.S.§9116(a)(1.2)].
• The ta�c rate�imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noled in pz as.gs��s�aK�)].
• The tax rate imposed on Me net value of transfers to or fw ihe use of the decedenYs siblings is 12 percent p2 P.S.§9116(a)(1.3)].A sibling is defined,
under Secti n 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
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REV4509 EX+40L10)
ennsylvania SCHEDULE F
EPAfi7MENTOFREVENUE �OINTLY-OWNED PROPERTY
I HERITANCETAXRETURN
ESIDENT DECEDENT
ESTATE OF: FILE NUM�ER:
Jud B. Da bach 0 0
If en asast wee made Jolntly owned wfthin one year of the deeadenPa dab of death,k muat be repoRed on Schedule G.
SURVIV NG JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
n. Kay G. K ne 42 Birchway sister
i Chambersburg, PA 17202
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e. Denise N{. Lucas 1431 Moosic Drive sister
Chamberburg, Pa 17202
C.
JOINTLY-OW ED PROPERTY:
LETi R DATE DESCRIPTIOM OF PROPERTY 9L OF DATE OF DEATH
. ITEM FOR J NT MADE INCLUDE NMIE OF FINANGAL INS'fITUfION AND BANKACCOUM NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF .
NUMBER TENA JOINT IDENTIFVINGNUMBER. ATTACHDEEDFORJOINTLY-HELDREALESTATE. VALUEOFASSET INTEREST DECEDENT'SINTEREST
t. A.and 8/1/94 14.88 acres of unimproved real estate located at 1,500.00 33.3 499.50
Cold Springa Road, Hamiftonban Township,
Adams County, Pennsylvania as described in Adams
County Record Book 921 at Page 131. Adams County
Tax Parcel number 18B13-0001-000. The real estate is
enrolled as torest reserve in Clean and Green and has a
Clean and Green land use value of$1,500. The common
level ratio is 1. The joint owners elect to have the real
estate valued as forest reserve pursuant to the provisions
of 72 PS Section 9122(b)(1)(iii).
TOTAL(Nso enter on Line 6,Recapitulation) S 499.50
�, If rtwre spaoa b needed,we eGtlXbnal eheeb M peper of Ihe same slze.
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REV-ui i �c.{io-os�
�pennsylvania SCHEDULE H
qEPARTMENTOF REVENUE FUNERAL EXPENSES AND
I�HERITANCE TAX RETURN ADMINISTRATIVE COSTS
SIDENT DECEDENT
ESTATE OF FiLE NUMBER
Judy B. Dambach 0 0
���, DecedenPs debls must ba roparted on Schedule[.
ITEM
RIUMBER , DESCRIPTION AMOUNT
A. ' FUNER4L EXPENSES:
L
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B. �I ADMINISTR4TIVE COSTS:
1. I Personai Representative Commissions:
li Name(s)of Personel Represenhtive(s)
II StreetAddrass
. . �I C�' � Slale ZIP
I
� I Yeahs)Commtssbn PaM:
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p, ntromey Fees: Teeter, Teeter, &Teeter 500.00
3. � Fartuly 6cemptbn:(If decedenCs address Is nM ihe same as dalmanfs,allach e:planation.)
Ckknent
. Street Addrass
. City Sta� ZIP
Relationship M Clahnant lo Decedent
4. �I p,�p��F�; Cumberland County Register of Wilis 15.00
� 5 I��I Aaountant Fees:
6. Taz Retum Preparer Fees:
7. Teeter, Teeter, &Teeter; reimbursement for tax assessment card 2.00
Note: The expenses on Schedule H have been paid by the recipients of the jointly
owned property described as Item 1 on Schedule F.
TOTAL(Also eMer an Line 9,Rerapkuladon) Z 517.00
��, It more space is needed,use additional sl�eeb d peper of the same size.
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THIS DEED 9�� �
I MADS TItS ��� day of �.c,u�..�..��G- in the year of our Lord
il one thousand �ine hundre nety-four (1994) ,
I BSRA�ESN �l1lRY S. AJlDGLS, wtdrn✓, of 1463 Hilltown Road, BigZerville,
I Adams County, Pennsylvan.te, perty of the first pert,
II Grantor,
I�I - a n d -
JUDY B. DAl�ACX, 3825 Vine Street, Camp Hill, Pennsylvanta 17011;
lUiY G. lUlNE, Chambersburq Road, Biglerville, Pennsy2vanta 17307;
and DSNISS !I. IACAS, 1431 Moos,ic Dr�ve, Chambersburg, Pennsylvanta
17201, ns joint tenants w�th �he r�ght of survivorshtp and not as
tenants in common, parties of the second part,
Grsntees,
NITNSSSSTE, that tn and for consideratton of the sum of One and
DO/10o' ($1.00) Do2lar, in hend patd, the recetpt whereof is hereby
acknowledged, the sa3d grantor does hereby qrant and convey to the
satd grantee, AI.L the rfght, title and control of the hereinatter
described tract of land sttuate .fn Hamiltonban Township, Adams
. County, Pennsylvania, which s�ie and Ira X. paugie, by thsir desd
datod April 10, 1990, artd reco�ded in the Oflia� of the Racordei o!'
D�da of 11da�s County, Psnnsylvania, reserved ao long a: they, or
either of them, ltved, said tract being more particularly bounded
and described as Pollows:
BBGI�IIPG at an iron pin along land of the Commonwealth
of Pennaylvanta at corner of land now or fors�erly of Wendell
W. Naugle; thence by satd Iand of the CommonweaZth ot
PennsyZvania, North 69 de�qrees 9 minutes West, 961.26 feet to
an iron pia tn existinq stones; thence conttnutng by land of
� the Commonwealth of Pennsylvania, North 28 degrees 21 m3nutes
II 10 secon8s Sast, 973 .60 �eet to e ra�lroad spike fn Township
Road T-307; thence in said Township Road and by land now or
formerly of Wendell W. Naugle, South 16 degrees 12 minutes 40
seconds East, 108 .97 feet to a raiZroad spike; thence
continuing in satd Township Road and by land now or formerly
of Wendell W. Naugle, SoUth 38 degrees 45 mtnutes 40 seconds
Eest, 375. 77 feet to a raiZroad spike; thence contir�uing in
sa�d Ta✓nshtp Road and by land now or formerSy of Wendell W.
Naugle, South 70 degrees 54 mtnutes Tiest, 150.23 feet to an
iron pin; thence continuing in setd Townshtp Road and by land
�4��;� 1 P��` ! � �
' �hedule F Itan 1
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now or tormerly oZ wendell [V. Naugle, North 87 degrees 55
m.inutes Snst, 176.98 feet to a railroad spike; thence by iand
now or formerly of Wendell W. Nauqle, South 11 degrees 4
m�nutes 50 seconds West, 772.98 feet to an iron ptn, the place
' of BE6IFNIPG. CONTAINIIYG 14 .875 acres.
II The forego3ng descrtption nas obtalned from a draft of
', survey dated May 13, 1974, by Boyer-Price Surveys, Inc.
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', BSIPG the same which Ira R. Naugle, et ai, by their deed
' dated April S0, 1990, recorded in Adams County Deed Book 314 at
page 1166 conveged unto Ira R. Naugle and Mary Z. Naugle and which
the lntter by thefr deed dated April 10, 2990, recorded in Adams
County Record Book 551 at page 1040 conveyed unto the Grantees
herein reserving, however, a11 right, tttle and control thereof es
long as they, or either of them, lived. The said Ira R. Naugle
dted on the /�.�day of ��, 1994 and Grantor hereby
conveys her remainlnq life estate to the persons holding the
remainder interest in such property, they being the Grantees
heretn.
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And the said Grantor hereby covenants and aqrees that she
will warrant specially the estnte hereby conveyed.
This conveyance is exempt from realty transfer tax as the
grantor herein is the mother of all granteea.
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IN WITNESS WHBREOF, said grantor has hereunto set her
I hand and seal the day and year first above written.
,I
II Signed, Saaled and Deltvered
i �n the Prasence of
�-� � � �� � (SEAL)
Nary Z Nnugle
ST1l'1'S OF PSNN3YLVAPIA .
. ss.
OOOIIR'Y OF 21DA1rl.S .
On this, the �°O�'� day of °'� 1994, betore me, the
undersiyned officer, personaZly a ared Mary Z. Naug2e, widow,
kno�*n to me (or aatisfactorily proven) to be the person n*hose name
is subscribad to the within tnetrument, and ackno�vledged that she
execated the same for the purpr�ses therein contained.
I2l NITNESS R�HSRE�DF, I hereunto set my hand and offic3al seal .
�`�.u�.r-.� �♦` �����.G_�
I NOta� �bllri ^``,�IN9ilI��FfVYp�1d..
� ��� 4�1�(itf �'�:
NOTAPoAL SEAL .Aw���' ��
JUOI7H A.ROHANNA,Notary PyWip � Q,.• ",� , '�r� �, ,
Gehysburg Bwo,Adams CouMy � ; „
: I �Mv Cammioaion Exoires Oct 7 t9B6 z ; � '�'��D��.`� � '
�
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i do hereby certify that the precise restdence and compSete Post
Oflice address of the nithin grantees ts 38/� Y1`:�e,.��'���-�
�-riya-' �--��� /a,9 /70 //
D3ted: ',��i..�/ � , 1994 GG•-��9��^Z-��"� � ��.�-�,
�— At ney for or
, �'��� � �� f ��
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N 9167
0�03-94 13:29JUDY 01 50885
F'EES 113.�
WRTT TAX l0.50
sr �is_ �o
[�il( Si3.S�
CG !0.�
REL�RDER QF DEEDS
ADiU13 CO qi
GETTYSHlMiOv PIa 1732°
�TTY H. PITZER
CFtlC 413.5C
� QB-03-94 13:29J1AY 01 5088°
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(Page�l of ) � �
t�VAl�lO COVl\i l .
CLEAN AND GREEN VALUATION APPLICATION ��,.°"'�',,,�""��
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.NPPLICATION—PFlIIiSYLVANL\PARMlAND ANDPORBST
"QBAN APID URBffid"
TO HE FQ�D BY JUNE 1 � w��s��
� DAT�: �'�1 �\\ .DATHOQ+SUBFIISSION: FAX;
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5599 602
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S700D a�Aa d�vaYd b�d ros M�aq�h�mem rd qWlQatlm�[ar W'�eu a ahe ooapemtlm Pa�oot ro a m�
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I�� Schedule F Item 1
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�. Hook: 5599 Yaqe: 602 eeq: 1
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ceage z of >
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P�nitWrvs �+KMnwsanu4�oeidMfa�rlYarotoy�sdaryWsdpadd�tlebroraY�a�aodpod�b.
5. rc�w rw eoc..nutlo.�ppo�liq.oY qye.ar duts rypr,qoh r�oar.ntio.qm«■&Rmr n�uyme�
P�Pb��4P�Y�ot�Y iofosmWae w�Yh yar qiptlivtim. 7LY d m�,howevar,a roquhemem(or w�EuWi�
n NP�k�eloe.
9. Far a9'�dditla�W Loi(xQs oaa w6ioh oipk be aiyibM Eor o�avalue�reume�hm for afiteh Y�do oo[iabod ro
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�� LAW OFFICES
'�, �ETER, TEETER&�ETER
��� 1 OB WESi MIDOLE STREET
GerrYSBUtcq PENNSY�,VAmA 17325-2108
DANIELE..}y�=.ETER Q911-199q 'IEI,EPHON6
RoaFacT G.'�F�rea 717-334-2195
SAMUEL E.'�ETER FAX
""' ' 717-334.2913
MATTF�W EI iEETER e-mail: bob�teeterlew.net
I October 9, 2013
I
Cumbe land County Register of Wills
1 Co ouse Square
Rm. 10
Cazlisl , PA 17013
File Nol 6332
Re: Est�te of Judy B. Dambach
Deaz Si or Madam:
Enclos d is the Pennsylvania inheritance tax retum in the above captioned estate for filing together with a check
in the s of$15.00 for the filing fee. As you will note,this return reports jointly owned property. There aze no
other p obate proceeds.
After f�ing the return, would you please return the receipt in the enclosed envelope along with the estate number
which ou have assigned.
Thank ou.
Very t ly yours,
TEET , EETER & TEETER � � � �
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